GDPR Subject Access Request Form

Subject Access Request

GUIDANCE ON REQUESTING PERSONAL INFORMATION

You can use this form to ask to see a copy of personal data that we hold about you, in line with the General Data Protection Regulations (GDPR).

You can also use this form to ask to see the records on behalf of someone else, as long as you are legally allowed to act on their behalf. This includes:

  • Making a request for a child
  • Making a request for someone that you have power of attorney for 
  • By written authorisation

The record holder may, however, withhold any information which might cause the patient or third party serious harm to their physical/mental health, or might identify a third party.

We aim to respond to all access requests within 30 days in line with GDPR guidance.

Notes for Completion of the Application Form

Please complete the Application Form attached in block capitals, clearly indicating whether you require all or part of your records for a particular treatment.

On Completion of the Form

Please forward the completed application form to:

Better Healthcare Services Limited

11-15 St Mary At Hill
 London
 EC3R 8EE
 

If you want to send your details be email, you may wish to password protect the documents and send the password under separate cover to protect your personal information. 

If you have any queries or would like further information about your rights for access to your records, please contact us by:

Telephone: 020 7929 2978

Email: dataprotectionofficer@betterhealthcare.co.uk

Section 1 - Please tell us the details below about you, or the person you are applying on behalf of

Section 2 - Personal details

If you have answered "Yes", go straight to Section 4. Otherwise, please provide the information below:

Section 3 - Consent from the Client

Hereby give my permission for:
to apply for my health/care records on my behalf.
Witness signature and name: (other than the applicant)

Please tick the appropriate box to indicate if you would like a copy of these records or just to view them:

Section 5 - Confirming your identity and address

Please do not send original documents. You can send printed copies or electronic copies.

Applying for yourself

If you are applying for yourself, we need to see:

  • One document confirming your name, from Group A, below
  • One document confirming your address, from Group B, below

Applying on behalf of someone else

If you are applying on behalf of someone else, we need to see:

  • One document confirming your name, from Group A, below
  • One document confirming the name of the person you are applying on behalf of, from Group A, below
  • One document confirming your address, from Group B, below
  • One document confirming the address of the person you are applying on behalf of from Group B, below
  • All documents needed to show that you have the authority to access the records, from Group C, below.

 A. Documents that confirm your name:

  • Full driving licence
  • Passport
  • Birth certificate
  • Marriage certificate
  • NHS Digital identity badge

 B. Documents that confirm your address:

  • Utility bill
  • Bank statement
  • Credit card statement
  • Benefit book
  • Pension book

 C. Documents that confirm you are allowed to act on behalf of the person you are making the request for:

  • Health and Welfare Lasting Power of Attorney
  • Court of Protection Order appointing you as a personal deputy for the personal welfare of the Subject
  • Full birth certificate of child
  • Full certificate of adoption
  • Parental responsibility order
  • Signed declaration from the subject

Please tell us which copies of documents you are providing:

Section 6 - Formal Declaration

In exercise of the right granted to me under the terms of the General Data Protection Regulations, I request that you provide me with the information I have requested. I confirm that this is all of the information to which I am requesting access. I also confirm that I am either the client, or am acting on their behalf. I am aware that it is an offence to unlawfully obtain such information, e.g. by impersonating the client. I certify that the information given in this form is true. I understand that it may be necessary for Better Healthcare Services to confirm my identity and it may be necessary to obtain more detailed information in order to confirm my identity and/or locate the correct information.